Consultation on services for people with personality disorders draws to a close

Daniel Lombard reports on the four options coming out of a consultation by primary care trusts

A major consultation into the future of services for adults with severe and complex personality disorders in the south of England ends this month.

Sixty-two primary care trusts in the London, South East Coast, South East Central and East of England regions have been seeking views on service reform over the past three months.

The PCTs are proposing to provide more people with care closer to home and the expansion of community outreach services. They are also consulting on how much “live-in” care – if any – is needed alongside these services.

Unsustainable model of care

They say the current model of care – in which services for all four regions are concentrated in London in two residential units, with additional beds purchased from the independent sector – is unsustainable and fails to meet service users’ needs.

Both are “therapeutic communities”, in which residents help run the centre and take part in group therapy sessions, but only one of them – the Cassel Hospital in Richmond – remains open.

The PCTs believe the £10m they spend each year on these specialist “tier four” services could be better used in other ways. They have put forward four options (see panel, right) for reform, ranging from having no residential units to four.

Specialist outreach teams

Each involves the creation of specialist community outreach teams in each of the four regions to identify potential service users, signpost people and families to appropriate treatment, offer follow-up care, and train fellow professionals.

While indicating no preference, the consultation document says having one unit, rather than the current two, “might provide the right number of spaces to be stable in the long-term”.

However, the issue is controversial, as evidenced by the fervent campaign last year by staff and patients to keep the Henderson open.

Support for the maintenance of residential services was on show at a consultation event attended by 25 users, carers and professionals in London this month.

Consultant psychiatrist in psychotherapy Diana Menzies, one of two remaining staff at the Henderson, which is still providing an outreach service, says residential care would provide the best form of treatment in the long-term.

“If the no-bed option is chosen, commissioners will still need places and will spot purchase from the independent sector, but they won’t be involved in the way that the service is run,” she says.

Live-in units

Anita Bracey, a campaigner and psychiatric nurse, says two live-in units would provide the most stability for people with personality disorders.

One carer says units should be spread out geographically, making it easier for relatives to visit their loved ones.

However, others feel service users may benefit from moving away from their home environment. “Sometimes it’s useful for people to move away from toxic situations,” according to one former resident of the Henderson Hospital.

Ann Malkin, clinical psychologist at Central and North West London NHS Foundation Trust, says it is imperative that any future model will receive proper financial support from PCTs.

Referral pathways

Social worker Martin Wrench, the other remaining Henderson team member, says referral pathways needed to be more flexible.

“People who were homeless or in prison didn’t have a prayer of getting into the Henderson unless they had a GP or community health team,” he says.

The consultation closes on 27 July, with a decision expected in November and any changes implemented from 2011.

Reform options suggested by a group of 62 PCTs:

● No residential units and with greater investment in day and outreach treatment, and acute inpatient beds on standby for people in crisis. Cost: £6m a year.

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